Transplants and Implants for Breast Reconstruction

Breast reconstruction after radiation may have a new option

(RxWiki News) Women who have had a mastectomy for their breast cancer treatment, have several options when it comes to reconstructive surgery. When they have received radiation as part of their treatment, the dynamics change somewhat.

There's a new choice for these women.

A new breast reconstruction technique has been developed for breast cancer patients who have undergone radiation.

The process involves several steps: using liposuction to obtain a woman's own fat tissue; injecting this fat into the area of the chest that was radiated; placing a breast implant into the transplanted tissue.

"Talk to your plastic surgeon about all the breast reconstruction options."

In a study directed by Dr. Salgarello Marzja of University Hospital "A. Gemelli" in Rome, researchers have found that this two-stage procedure of injecting a woman's own fat to provide a "bed" for the breast implant, may solve the unique needs of women who've had radiation.

"Fat grafting seems to reduce the radiation-induced complications in implants," Dr. Marzja explained.

Radiation following surgery is the norm for many breast cancer patients. The radiation kills any remaining cells and helps to prevent a recurrence of the disease.

Because the radiation has toxic effects that can delay and complicate healing, women who've had this treatment aren't usually good candidates for implants. Instead, their only option, generally, is to use their own tissue for what's known as autologous reconstruction.

During this three-year study, researchers used the combination technique with 16 women with breast cancer who'd had had surgery followed by radiation - 11 had mastectomy and five had lumpectomy (breast-conserving therapy). Reconstruction began 3-6 months after the radiotherapy had finished.

The technique involves using liposuction to obtain from one part of the body - just as the thigh or back. That tissue is then injected into the area that's been radiated to provide a lining or "bed" of healthy tissue to cushion the implant.

Patients had two or three of these fat grafts. Reconstruction was completed when all signs of radiation toxicity were gone.

This staged procedure was encouraging, according to the authors. The women were satisfied with the procedure and 94 percent were pleased with the appearance of the reconstructed breast. Follow-up at 15 months found no complications, and patients healed well.

Gedge Rosson, M.D., associate professor of plastic and reconstructive surgery at the Johns Hopkins School of Medicine, told dailyRx that he would recommend women who've had radiation to discuss the technique with "a Board-certified (American Board of Plastic Surgeons) plastic surgeon who does a high-volume of breast reconstruction at a well-recognized breast center that offers the full-spectrum of breast cancer care and reconstructive options, including microsurgical reconstruction such as DIEP flaps."

The DIEP technique uses a flap of abdominal skin and fat to reconstruct the breast, without involving any muscle tissue.

"Some patients will still have a better long-term result with purely autologous (from your own body) tissue and no implant," Dr. Rosson said.

Dr. Marzja said larger studies are needed to confirm the findings of this research, published in February, 2012 issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons.

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Review Date: 
February 2, 2012